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Abstract：
Bicuspid aortic valve (BAV) disease is associated with increased risk of aortopathy. In addition to current intervention guidelines, BAV mediated changes in aortic 3D hemodynamics have been considered as risk stratification measures. We aimed to evaluate the association of 4D flow cardiovascular magnetic resonance (CMR) derived voxel-wise aortic reverse flow with aortic dilation and to investigate the role of aortic valve regurgitation (AR) and stenosis (AS) on reverse flow in systole and diastole.
510 patients with BAV (52 ± 14 years) and 120 patients with trileaflet aortic valve (TAV) (61 ± 11 years) and mid-ascending aorta diameter (MAAD) > 35 mm who underwent CMR including 4D flow CMR were retrospectively included. An age and sex-matched healthy control cohort (n = 25, 49 ± 12 years) was selected. Voxel-wise reverse flow was calculated in the aorta and quantified by the mean reverse flow in the ascending aorta (AAo) during systole and diastole.
BAV patients without AS and AR demonstrated significantly increased systolic and diastolic reverse flow (222% and 13% increases respectively, p < 0.01) compared to healthy controls and also had significantly increased systolic reverse flow compared to TAV patients with aortic dilation (79% increase, p < 0.01). In patients with isolated AR, systolic and diastolic AAo reverse flow increased significantly with AR severity (c = - 83.2 and c = - 205.6, p < 0.001). In patients with isolated AS, AS severity was associated with an increase in both systolic (c = - 253.1, p < 0.001) and diastolic (c = - 87.0, p = 0.02) AAo reverse flow. Right and left/right and non-coronary fusion phenotype showed elevated systolic reverse flow (> 17% increase, p < 0.01). Right and non-coronary fusion phenotype showed decreased diastolic reverse flow (> 27% decrease, p < 0.01). MAAD was an independent predictor of systolic (p < 0.001), but not diastolic, reverse flow (p > 0.1).
4D flow CMR derived reverse flow associated with BAV was successfully captured even in the absence of AR or AS and in comparison to TAV patients with aortic dilation. Diastolic AAo reverse flow increased with AR severity while AS severity strongly correlated with increased systolic reverse flow in the AAo. Additionally, increasing MAAD was independently associated with increasing systolic AAo reverse flow. Thus, systolic AAo reverse flow may be a valuable metric for evaluating disease severity in future longitudinal outcome studies.
510 patients with BAV (52 ± 14 years) and 120 patients with trileaflet aortic valve (TAV) (61 ± 11 years) and mid-ascending aorta diameter (MAAD) > 35 mm who underwent CMR including 4D flow CMR were retrospectively included. An age and sex-matched healthy control cohort (n = 25, 49 ± 12 years) was selected. Voxel-wise reverse flow was calculated in the aorta and quantified by the mean reverse flow in the ascending aorta (AAo) during systole and diastole.
BAV patients without AS and AR demonstrated significantly increased systolic and diastolic reverse flow (222% and 13% increases respectively, p < 0.01) compared to healthy controls and also had significantly increased systolic reverse flow compared to TAV patients with aortic dilation (79% increase, p < 0.01). In patients with isolated AR, systolic and diastolic AAo reverse flow increased significantly with AR severity (c = - 83.2 and c = - 205.6, p < 0.001). In patients with isolated AS, AS severity was associated with an increase in both systolic (c = - 253.1, p < 0.001) and diastolic (c = - 87.0, p = 0.02) AAo reverse flow. Right and left/right and non-coronary fusion phenotype showed elevated systolic reverse flow (> 17% increase, p < 0.01). Right and non-coronary fusion phenotype showed decreased diastolic reverse flow (> 27% decrease, p < 0.01). MAAD was an independent predictor of systolic (p < 0.001), but not diastolic, reverse flow (p > 0.1).
4D flow CMR derived reverse flow associated with BAV was successfully captured even in the absence of AR or AS and in comparison to TAV patients with aortic dilation. Diastolic AAo reverse flow increased with AR severity while AS severity strongly correlated with increased systolic reverse flow in the AAo. Additionally, increasing MAAD was independently associated with increasing systolic AAo reverse flow. Thus, systolic AAo reverse flow may be a valuable metric for evaluating disease severity in future longitudinal outcome studies.
摘要：
背景：双叶主动脉瓣（BAV）疾病与主动脉病风险增加相关。除了目前的干预指南，BAV介导的主动脉3D血流动力学变化已被认为是危险分层措施。我们旨在评估4D血流心血管磁共振（CMR）衍生的体素式主动脉反向血流与主动脉扩张的关系，并研究主动脉瓣反流（AR）和狭窄（AS）在收缩期和舒张期中对反向血流的作用。
方法：510例BAV患者（52±14岁）和120例三叶主动脉瓣（TAV）（61±11岁）和升主动脉中径（MAAD）>35mm的患者进行了CMR，包括4D流量CMR。选择年龄和性别匹配的健康对照队列(n=25,49±12岁)。计算主动脉中的体素反向流量，并通过收缩期和舒张期升主动脉（AAo）中的平均反向流量进行量化。
结果：无AS和AR的BAV患者表现出收缩期和舒张期反向血流明显增加（分别增加222%和13%，p<0.01）与健康对照组相比，与主动脉扩张的TAV患者相比，收缩期反向血流也显着增加（79％增加，p<0.01)。在孤立性AR患者中，随着AR严重程度的增加，收缩期和舒张期AAo反向流量显着增加（c=-83.2和c=-205.6，p<0.001）。在孤立性AS患者中，AS严重程度与收缩压（c=-253.1，p<0.001）和舒张压（c=-87.0，p=0.02）AAo逆流增加相关。右和左/右和非冠状动脉融合表型显示收缩期反向血流升高（>17％增加，p<0.01)。右侧和非冠状动脉融合表型显示舒张期反向血流减少（减少>27%，p<0.01)。MAAD是收缩期的独立预测因子(p<0.001),但不是舒张压，逆流（P>0.1）。
结论：与主动脉扩张的TAV患者相比，即使在没有AR或AS的情况下，也能成功捕获与BAV相关的4D血流CMR衍生的反向血流。舒张性AAo反向流量随AR严重程度而增加，而AS严重程度与AAo的收缩期反向流量增加密切相关。此外,MAAD的增加与收缩期AAo反向血流的增加独立相关。因此，在未来的纵向结局研究中,收缩期AAo逆流可能是评估疾病严重程度的有价值的指标.
方法：510例BAV患者（52±14岁）和120例三叶主动脉瓣（TAV）（61±11岁）和升主动脉中径（MAAD）>35mm的患者进行了CMR，包括4D流量CMR。选择年龄和性别匹配的健康对照队列(n=25,49±12岁)。计算主动脉中的体素反向流量，并通过收缩期和舒张期升主动脉（AAo）中的平均反向流量进行量化。
结果：无AS和AR的BAV患者表现出收缩期和舒张期反向血流明显增加（分别增加222%和13%，p<0.01）与健康对照组相比，与主动脉扩张的TAV患者相比，收缩期反向血流也显着增加（79％增加，p<0.01)。在孤立性AR患者中，随着AR严重程度的增加，收缩期和舒张期AAo反向流量显着增加（c=-83.2和c=-205.6，p<0.001）。在孤立性AS患者中，AS严重程度与收缩压（c=-253.1，p<0.001）和舒张压（c=-87.0，p=0.02）AAo逆流增加相关。右和左/右和非冠状动脉融合表型显示收缩期反向血流升高（>17％增加，p<0.01)。右侧和非冠状动脉融合表型显示舒张期反向血流减少（减少>27%，p<0.01)。MAAD是收缩期的独立预测因子(p<0.001),但不是舒张压，逆流（P>0.1）。
结论：与主动脉扩张的TAV患者相比，即使在没有AR或AS的情况下，也能成功捕获与BAV相关的4D血流CMR衍生的反向血流。舒张性AAo反向流量随AR严重程度而增加，而AS严重程度与AAo的收缩期反向流量增加密切相关。此外,MAAD的增加与收缩期AAo反向血流的增加独立相关。因此，在未来的纵向结局研究中,收缩期AAo逆流可能是评估疾病严重程度的有价值的指标.
